MEDICARE: LINDA B FLAHERTY PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	LP5119	MN
2	103TC0700X	Clinical Psychologist	LP5119	MN

General Provider Information

NPI Number	:	1720211014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA B FLAHERTY PH.D

Provider Business Mailing Address
First Line	:	4616 FLAGSHIP DR
Second Line	:	#102
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4580
Country	:	US
Telephone Number	:	239-292-5176
Fax Number	:	239-482-1796

Provider Business Practice Location Address
First Line	:	4616 FLAGSHIP DR
Second Line	:	#102
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4580
Country	:	US
Telephone Number	:	239-292-5176
Fax Number	:	239-482-1796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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